Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 056416 | NY |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DRP910 | FL |
NPI | 1043527179 |
---|---|
Provider Name | Dr. Amjad Hasan Pirzada |
First Address | Wellington, FL 33414-9385 |
Second Address | Wellington, FL 33414-9385 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2010 |
Last Update Date | 20/01/2015 |